MEDICARE: NESTOR A LAYSA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	05008982A	IN
2	225100000X	Physical Therapist	030150	NY

General Provider Information

NPI Number	:	1740479799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NESTOR A LAYSA PT

Provider Business Mailing Address
First Line	:	714 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Provider Business Practice Location Address
First Line	:	714 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3502
Country	:	US
Telephone Number	:	718-327-7457
Fax Number	:	718-327-7539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	02/25/2010

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